Provider Demographics
NPI:1922253251
Name:DAVIS, PAUL EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10022 PACIFIC AVE
Mailing Address - Street 2:P.O. BOX 190
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-1837
Mailing Address - Country:US
Mailing Address - Phone:847-678-5130
Mailing Address - Fax:847-678-5168
Practice Address - Street 1:10022 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-1837
Practice Address - Country:US
Practice Address - Phone:847-678-5130
Practice Address - Fax:847-678-5168
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036066287207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology